Jekyll and Hyde

Can an herbal supplement do harm? If misused – yes. As an e-Alert reader you already know this. But the general public still seems shocked to find out that “natural,” and “herbal” are not necessarily synonyms for “perfectly safe.”

In an e-Alert I sent you last week (“Consumer Retort” 1/8/03), I told you about an article I found in Consumer Reports magazine that called for a ban of ephedra, the controversial herbal that can cause problems (and in some cases death) when it’s inappropriately used.

The responses I received from that e-Alert provide exactly the sort of balanced look at the ephedra issue that was sorely missing from the Consumer Reports article.

More than meets the eye

“I took a product (probably a weight reduction pill) some months ago with ephedra in it and immediately began heart palpitations.”

That e-mail from an HSI member named Phyllis was echoed by another comment on the HSI Forum, posted by Bonnie: “In 1985 I used a product with ephedra in it and I had a very bad experience with my heart. It was supposed to be helpful for my asthma but instead it caused my heart to beat so hard and fast that I thought it would stop completely.”

If I were sitting around a table with Phyllis and Bonnie, I’d have a number of questions for them. First I’d want to know if either of them had drunk a cup of coffee, tea or a cola around the same time they took the ephedra. (Caffeine is contraindicated for ephedra.) I’d also want to know if they had experienced any cardiovascular problems previous to taking the ephedra. But most importantly, I’d ask them if they were absolutely certain that the products they used contained ephedra, or, instead, a common drug called ephedrine.

Ephedrine and pseudoephedrine are drugs that are both isolated from ephedra, and both have actions similar to amphetamine. Ephedrine is a common component of many diet products, and is often used to treat asthma. Both drugs are also available in nonprescription strength to relieve sinus congestion. In fact, Sudafed takes its name from pseudoephedrine.

With these drugs on the market, the whole issue of ephedra dangers becomes clouded, doing the herb no favors at all.

The dubious boost

One of the e-mails I received about ephedra came from Linda Page, N.D., Ph.D. – a noted nutritionist, author, and an HSI Panelist. Dr. Page has been a Classical Herbalist for almost 30 years and has formulated over 250 effective whole herb combinations, many of them containing ephedra. Dr. Page writes:

“I am continually distressed about ephedra’s misuse and abuse, most importantly the isolated component of ephedra, ephedrine. If herbalists and formulators lose the ability to use ephedra, we are losing one of the best broncho-dilators from the plant kingdom that is extremely valuable when used for asthma and allergies. What then would people have to choose from to alleviate their symptoms? Drugs of course.

“Ephedra also has thermogenic qualities so it is very effective for weight loss. Weight loss product manufacturers know this, and in most cases, the ephedrine is isolated and boosted so that the end result is people are taking a dangerously high amount. Further, when ephedrine is isolated and boosted, it becomes an herbal ‘drug.’

“In the whole plant, ephedrine accounts for approximately 1%. In a whole herb formulation, there may be up to 50mg of ephedra, which in its whole form is an effective dose, yielding .5mg of ephedrine. Products with isolated ephedrine may be up to 20mg of ephedrine! It is no wonder there are problems!

“Remember, too, that whole plants are foods and taken into the body through enzyme activity. Drugs, even herbal drugs, are not. In addition, whole plants have protective qualities built in. Drugs, even herbal drugs, do not.

“Ephedra when used correctly and with common sense is a safe, effective herb and it would be terribly wrong to lose it on account of its misuse and abuse.”

Keeping our heads

The misuse and abuse of ephedra may account for most, if not all, of the most serious problems that have been associated with the herb. It’s easy to imagine, for instance, someone taking ephedra in the morning to help control their asthma, adding a dose of Sudafed at noon to treat a sinus headache, and then taking a coffee break later in the day.

This simple combination could easily trigger a health crisis – especially if the person has a developing heart condition they’re not yet aware of. Does it make sense to blame one of these components for the danger created by the combination of the three?

As I said in last week’s e-Alert, ephedra is a potent botanical that should always be used with caution. Several years ago, herbal product manufacturers recognized the potential dangers of ephedra and immediately began a program to educate the public about the special concerns of using this controversial, but beneficial herb. In the meantime, the isolated cases of ephedra abuse will hopefully not undermine that process.

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To Your Good Health,

Jenny Thompson
Health Sciences Institute